Of sex and science. Elizabeth Pisani's blog about HIV and other sundry things.

20/02/08

A study in Mozambique looks at what is killing women during childbirth or over the following 42 days. We tend to think of “maternal mortality” as deaths from haemorrhage or other obstetric complications, but in this case, more women died of infectious diseases than of pregnancy-or-delivery-gone-wrong. And of the infectious diseases, the biggest killer was HIV.

This is surprising in a one small way. Once HIV has started bashing down a woman’s immune system, she’s less likely to get pregnant. So it was astonishing to find that 53% of the pregnant women who died were HIV-infected (compared with an average in the Maputo region of 21%). But in a much bigger way, it is not a bit surprising. HIV kills people, and there’s no reason it would avoid killing women who have recently been pregnant or given birth (though the paper, published in the wonderful, open-access Public Library of Science, does not address the interesting question of whether pregnancy might actually accelerate HIV disease).

The paper comes up with the not-very-insightful conclusion that if we did more to prevent and treat diseases in women who get pregnant, fewer women who get pregnant would die. But hell, if the goal of reducing maternal mortality (one of the gloriously Quixotic Millenium Development Goals) somehow encourages us to reverse our failure to reduce HIV (another Millenium Development Goal), it can only be a good thing. Though of course if it’s just a matter of meeting the goals, we could take another approach to avoiding maternal mortality related to HIV infection. Contraception for HIV-infected women would do the trick.

Update: Chris Green brings my attention to an observational study which suggests, inconclusively, that pregnant women with HIV may have slower disease progression than women who don’t get pregnant. See here for more.